Grant: Meetings, Planning and Dissemination Grant: Circulatory and Respiratory Health

As a result of persistent shortages in organs for transplantation, the practice of donation after cardiac death (DCD) has been given reconsideration and wide endorsement. In Canada, DCD remains uncommon, as the criteria used to establish irreversibility of cardiocirculatory function are controversial and not evidence based. Some in the medical community have questioned whether those who become organ donors after cardiac arrest are really dead. There has been no rigorous attempt to resolve the uncertainty of how long one should wait to determine death following a cardiac arrest to ensure irreversibility and yet be able to maintain organ viability. For DCD to proceed, a research study, with the purpose of clearly observing and documenting the physiologic changes that occur during the dying process following withdrawal of life sustaining therapies, is required. Studying dying patients in the critical care environment presents many practical, technical and ethical challenges. To be successful, such a study requires the collaboration, input and support of a multi-disciplinary team that includes health care professionals involved in the practical and ethical aspects of organ donation, as well as researchers with expertise in critical care, ethics, study methodology, biostatistics, and biomechanical engineering. Thus we are planning a Consensus Conference to bring together knowledge users, researchers and other relevant stakeholders to develop a comprehensive research protocol and funding plan, the results of which would direct the development and implementation of robust Canadian guidelines and standards for the determination of death after cardiac arrest, for the purpose of DCD. By including important stakeholders and collaborators early in the development phase, we can identify strategies that will enable us to translate the results of this research into practice and policy. This proposed research program has been endorsed by the Canadian Critical Care Trials Group.